TO: Dr. Aparna Roy, Chief of Pediatrics, Metrohealth, aroy@metrohealth.org
Dr. Marlene Miller, Chief of Pediatrics, University Hospitals, Marlene.Miller@UHhospitals.org Dr. Kimberly Giuliano, Vice Chief, Children’s Institute; Chair, Department of Primary Care Pediatrics, Cleveland Clinic Foundation, GIULIAK@ccf.org
FROM: Cuyahoga County Division of Child and Family Services (DCFS) Community Advisory Board RE: Critical Need for Board-Certified Child Abuse Pediatrician in Cuyahoga County DATE: August 7, 2024 – APPROVED September 4, 2024
We write on behalf of the DCFS Community Advisory Board. The Advisory Board was created in 2019 following the untimely death of Aniya Day-Garrett. We consist of ten community volunteers who were appointed by County Executive Ronayne, approved by the County Council, and asked to provide community-based, independent feedback to the DCFS and County leadership. In this capacity, we have advocated for several system changes to promote the safety and well-being of the children and families in our county, including the adoption of the county-wide medical child protection team (CPT).
We commend your individual institutions for choosing to participate the county-wide medical CPT. A robust CPT provides a more comprehensive, coordinated approach for the early identification and treatment of child abuse, and it strengthens the overall protection of the children in our county. Specifically, the CPT is designed to ensure cross-system collaboration. The coordinated sharing of information across medical institutions and social service agencies is essential to prevent and reduce child abuse and neglect in real time. A robust CPT will also allow for
improved referrals, comprehensive assistance to families, and a thorough follow-up on previous cases.
Again, we are very encouraged that the three major hospital systems are engaged with Canopy in this collaborative effort. That said, we are deeply concerned that the key position of a board-certified child abuse pediatrician has remained unfilled to date. The fact that Cuyahoga County is without a single board-certified child abuse pediatrician is alarming given our county’s high prevalence of child abuse and neglect. More importantly, it undermines the effectiveness and sustainability of the county-wide CPT by not having the requisite medical expertise to direct the indicated examinations, referrals, and follow up. Specifically, the CPT is intended to provide physical abuse examinations (in addition to sexual abuse examinations), and an experienced, board-certified medical profession is necessary to identify or exclude physical abuse. This enables proper decisions on safety to be made with the first examination, and it allows those families who are not in need of a safety plan to move on without the added trauma of repeated examinations. While sexual assault nurses can provide an examination for sexual abuse, they cannot do so for physical abuse by their credentialing, and they may lack experience in this area. Although Nurse Practitioners may conduct a physical abuse examination, they too must have experience in the identification of physical abuse, which is uncommon. Moreover, Nurse Practitioners still must have a collaborating physician with experience in physical child abuse to review their work and to sign off on their documentation. As such, a board-certified child abuse pediatrician is integral to the CPT model; without one, physical abuse examinations at Canopy or as a part of the CPT cannot be accomplished. This gap in expertise threatens the ultimate success of the CPT.
We urge your institutions to make every effort to expediate the recruitment of a board-certified child abuse pediatrician to sustain the county-wide CPT. We understand that identifying pediatricians with this expertise is a challenge, but the alternative is simply untenable. The most vulnerable children in Cuyahoga County deserve a board-certified child abuse pediatrician to champion their cause. Ultimately, we believe the driving goal of the CPT is to not only prevent future child tragedies but to help ensure that families at risk have the needed supports and resources to help raise their children in loving, safe and stable homes. We, and the rest of the county, will continue to look to you and your institutions for the collaborative leadership needed to make Cuyahoga County a healthier place for our children.
Thank you for the opportunity to share our concerns. We would appreciate a timely response. Please contact Gabriella Celeste (mgc36@case.edu) or Angela Newman-White (axn656@case.edu).
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